Open Pyeloplasty for Pediatric Ureteropelvic Junction Obstruction at Herat Regional Hospital

Objectives: Ureteropelvic junction obstruction (UPJO) is a leading cause of congenital hydronephrosis, potentially leading to progressive renal damage if untreated. Open dismembered pyeloplasty is the historical gold standard for correction, particularly in low-resource settings where minimally invasive techniques are less accessible. This study evaluates the outcomes of this procedure at Herat Regional Hospital. Methods: A retrospective case series was conducted on pediatric patients who underwent open dismembered pyeloplasty for UPJO. We analyzed patient demographics, pre-operative clinical and imaging findings, intraoperative details, and post-operative outcomes, including success rates and complications. Success was defined as symptomatic improvement and reduction in hydronephrosis on follow-up ultrasonography. Results: A total of 48 patients were included, with a significant male predominance (79.2%). The mean age at surgery was 5.8 years. The most common presentation was flank pain (41.7%), and all patients had severe (Grade 3 or 4) hydronephrosis pre-operatively. The overall success rate of open pyeloplasty was 95.8%. The mean hospital stay was 4.5 days. Post-operative complications were minimal, with surgical site infection occurring in two patients (4.2%) and no cases of urinary leakage or obstruction recurrence requiring re-intervention during the follow-up period. Conclusion: Open pyeloplasty is a highly effective, safe, and durable surgical treatment for pediatric UPJO within our institution. Its excellent outcomes confirm its continued role as the standard of care in settings where open surgical expertise is the primary available resource.